Very elderly do well after planned surgery

NEW YORK -- Many very old people who have undergone planned surgery are doing well years later, but elderly individuals requiring unplanned surgery or intensive care unit (ICU) treatment for medical reasons are far less likely to survive, Dutch researchers report.

Elderly ICU patients may not be given life-saving therapy, due to concerns that such treatments are “overly burdensome and not necessarily beneficial,” Dr. Sophia E.J A. de Rooij and colleagues from Academic Medical Center in Amsterdam write. However, they add, such decisions should be made based on both the anticipated benefits and patients’ preferences, not just their age.

To examine how well older patients actually do after spending time in an ICU after surgery or for medical reasons, de Rooij and her team looked at 204 surviving patients from a group of 578 who had been admitted to a medical-surgical ICU between 1997 and 2002.

The patients’ average age upon admission was about 82. All were alive in December 2003, and they were followed up 3.7 years after they had been discharged.

Fifty-seven percent of those who had undergone planned surgery were still alive, while just 11 percent of those who had emergency surgery and 10 percent requiring medical ICU treatment had survived, the team reports in the Journal of the American Geriatrics Society.

Among the patients who lived at home when they were admitted to an ICU, 74.3 percent were still living independently at follow-up. Just 17 percent of all of the surviving patients had severe cognitive impairment, while 24 percent had severe functional impairment.

“These results do not suggest that all very elderly ICU patients have a good prognosis,” the researchers write, noting that most patients admitted to the hospital for unplanned surgery or medical ICU treatment survive for just one month.

Nevertheless, they add, the long-term health-related quality of life for the patients who had planned surgery was virtually equal to that of an age-matched group from the general population.